Tuberculosis is a major health problem in developing nations. Spine is the most commonly affected site for skeletal tuberculosis but involvement of sacrum is rare. Isolated involvement of sacrum has been reported in literature but none of the reports has mentioned its clinical presentation as monoparesis. Our case presented with symptoms of sensory and motor deficit in right lower limb. The magnetic resonance imaging spine and non contrast computerized tomogram revealed a sacral lesion but were inconclusive of diagnosis. Histological examination after computed tomography guided biopsy revealed the condition as tuberculosis. Anti tubercular treatment was started after confirmation of diagnosis and continued for 18 months. Erythrocyte sedimentation rate and C-reactive protein drooped to normal range and patient was symptom free at two-year follow up. This case report intends to emphasize that sacral tuberculosis, being itself a rare condition, may present atypically as monoparesis.
Anti-Bacterial Agents ; Biopsy ; Blood Sedimentation ; C-Reactive Protein ; Developing Countries ; Diagnosis ; Follow-Up Studies ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Paresis* ; Reference Values ; Sacroiliac Joint ; Sacrum* ; Spine ; Tuberculosis*

OBJECTIVETo define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures.

METHODSThis study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries.

RESULTSIn the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in patients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high.

CONCLUSIONAnterior approach to the pelvis would cause significantly more amount of blood loss than posterior approach and external fixation. Surgical approaches do not have any influence on the surgical duration or the infection rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influenced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient's survival and it greatly influences the duration of hospital stay.

Adolescent ; Adult ; Aged ; Child ; Female ; Fractures, Bone ; surgery ; Humans ; Length of Stay ; Male ; Middle Aged ; Pelvic Bones ; injuries ; surgery ; Prospective Studies ; Time Factors ; Treatment Outcome

STUDY DESIGN: Cross-sectional study. PURPOSE: The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient's disability level, using the Oswestry Disability Index (ODI). OVERVIEW OF LITERATURE: The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods. METHODS: Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the national-language translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles. RESULTS: No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores. CONCLUSIONS: Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis.
Constriction, Pathologic* ; Cross-Sectional Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Methods ; Observational Study* ; Radiculopathy ; Research Design